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POLICY NUMBER: BAP 0112780-11 COMMERCIAL AUTO <br />CA 04 44 10 13 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />WAIVER OF TRANSFER OF RIGHTS OF RECOVERY <br />AGAINST OTHERS TO US (WAIVER OF SUBROGATION) <br />This endorsement modifies insurance provided under the following: <br />AUTO DEALERS COVERAGE FORM <br />BUSINESS AUTO COVERAGE FORM <br />MOTOR CARRIER COVERAGE FORM <br />With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless <br />modified by the endorsement. <br />This endorsement changes the policy effective on the inception date of the policy unless another date is indicated <br />below. <br />Named Insured:STEARNS, CONRAD AND SCHMIDT, CONSULTING ENGINEERS, INC. <br />Endorsement Effective Date: <br />SCHEDULE <br />Name(s) Of Person(s) Or Organization(s): <br />ALL PERSONS AND/OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN <br />CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE <br />ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER <br />THIS POLICY <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />The Transfer Of Rights Of Recovery Against <br />Others To Us condition does not apply to the <br />person(s) or organization(s) shown in the Schedule, <br />but only to the extent that subrogation is waived prior <br />to the “accident” or the “loss” under a contract with <br />that person or organization. <br />CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 <br />Attachment Code: D693755 Certificate ID: 23603987 <br />Docusign Envelope ID: F16F78DC-0519-8237-830C-9B7D5391A9A3